Abstract
The optimum control of seizures requires adequate dosing of appropriately selected anti-epileptic medications. The availability of AEDs in Nigeria is limited and this constrains the prescription latitude of clinicians. This study was conducted to describe the prescribing pattern of anti-epileptic drugs in the outpatient service of a psychiatric facility in southeast Nigeria. The case records of the epileptic patients attending the outpatient clinic of a psychiatric hospital were retrieved, reviewed and data abstracted with a prepared proforma. The information extracted include age, sex, marital status, residence, type of seizure and anti-seizure medications prescribed, frequency of administration and dosage among other variables. Of the 178 patients whose prescriptions and case records were assessed, males constituted 62.9% and females 37.1%. Most of the patients were single (78.1%) and the group had a mean age of 25.6 ± 10.9 years. Generalized tonic-clonic seizures predominated (61.2%) among the seizure types, whilst complex partial seizure type was identified in 35.4% of the patients. Patient diagnosis relied heavily on the use of clinical description alone. About 92.7% of the patients were treated with monotherapy, whereas 7.3% received two anti-epileptic drug combinations. Carbamazepine was the most frequently prescribed drug, and was utilized in the treatment of 87.9% of patients receiving monotherapy and 92.3% of individuals receiving two drug combinations. Adjunctive medications like benzodiazepines were rarely utilised to improve the effect of the AEDs. The patients that received polytherapy could only be distinguished from those that received monotherapy by higher frequency of epileptic auras and higher mean dose of AEDs per day. The predominant use of monotherapy is in accordance with the treatment recommendations and needs to be encouraged. The greater use of carbamazepine is probably related to its perceived benefits in the control of behavioural symptoms.
Highlights
Epilepsy is one of the major neurological syndromes whose psychological and behavioural manifestations may result in psychiatric presentation, sometimes very early in the illness trajectory
The case records of the epileptic patients attending the outpatient clinic of a psychiatric hospital were retrieved, reviewed and data abstracted with a prepared proforma
Prevalence studies suggest rates of almost 50% for psychiatric disorders among epileptic patients [5] [6] [7] and raise the necessity for active psychiatric case finding in epilepsy treatment centres
Summary
Epilepsy is one of the major neurological syndromes whose psychological and behavioural manifestations may result in psychiatric presentation, sometimes very early in the illness trajectory. Even when the seizures cannot be controlled completely, a reduction in their frequency and severity can contribute immensely to enhancing the patient’s quality of life and general wellbeing [10] [11] [12]. The rational use of antiepileptic drugs in settings with limited resources necessitate the evaluation and audit of their prescribing patterns in relation to efficacy in seizure control and patient wellbeing enhancement [11] [13]. In Nigeria, the availability of anti-epileptic drugs is limited to a few medications for generalized and partial seizures, and this constrains the prescription latitude of the clinicians, notwithstanding their understanding of the spectrum of potential pharmacological agents that could be more appropriate in specific circumstances. The choice of an anti-epileptic drug can exacerbate the psychiatric symptomatology a patient experiences [15]
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